1476P - Comparison of the usage of granulocyte colony-stimulating factors (G-CSF) in the Baltic and Nordic countries in 2011-2014

Date 09 October 2016
Event ESMO 2016 Congress
Session Poster display
Topics Supportive Measures
Presenter Elen Vettus
Citation Annals of Oncology (2016) 27 (6): 497-521. 10.1093/annonc/mdw390
Authors E. Vettus1, K. Kurvits2, K. Oselin1
  • 1Department Of Chemotherapy, North Estonia Medical Centre, 13419 - Tallinn/EE
  • 2Department Of Post-authorisation Safety, State Agency of Medicines, Tartu/EE



We aimed to analyse the use of G-CSF in the Nordic and Baltic countries and to compare the use of short- (filgrastim and its analogs) and long-acting (pegfilgrastim) G-CSFs in three cancer centres in Estonia with similar patient profile and identical reimbursement system.


G-CSFs were classified according to the Anatomical Therapeutic Chemical (ATC) classification (2015), the number of defined daily doses (DDD) per 1000 inhabitants per day was used as a measurement (DDD is 350 mcg for filgrastim and 300 mcg for pegfilgrastim). National consumption data (based on wholesale data) of G-CSF in the Nordic and Baltic countries were obtained from the Estonian Agency of Medicines. Dispensed G-CSF in three cancer centres in Estonia was obtained from hospital pharmacies. Number of patients and chemotherapy courses delivered per year per hospital were retrieved from the Estonian Health Insurance Fund and were compared with the dispensed G-CSF in each hospital.


The use of G-CSF in the Nordic and Baltic countries in 2011-2014 using DDD/1000 inhabitants/day

Year Finland Norway Sweden Denmark Lithuania Latvia Estonia EE-1* EE-2* EE-3*
2011 0.2 0.1 0.04 0.1 0.04 0.07 0.03 0.37 0.67 0.12
2012 0.19 0.11 0.03 0.1 0.06 0.08 0.04 0.43 0.77 0.10
2013 0.16 0.12 0.03 0.2 0.07 0.1 0.05 0.57 1.0 0.13
2014 0.16 0.14 0.03 0.2 0.08 0.1 0.06 0.64 1.0 0.20

*Dispensed G-CSF (0,3mg) per chemotherapy courses in three cancer centres in Estonia In 2014 the consumption of G-CSF in Sweden was 85% lower than in Denmark, Denmark and Finland using only pegfilgrastim. Latvia has used the most G-CSF when compared to other Baltics and in 2013 their use of long-acting G-CSF was 8 times higher than in Lithuania. Filgrastim was the most used G-CSF in Estonia, G-CSF consumption varied 5 fold between cancer centres.


According to the national medicines use data the overall consumption of G-CSFs is highly variable in the Nordic and Baltic countries despite clear and updated guidelines by ESMO and ASCO. Consumption of G-CSFs has steadily increased in the three Baltic countries, most likely due to the availability of filgrastim biosimilars. The observed remarkable differences between use of G-CSF in the Nordic countries are difficult to explain.

Clinical trial identification

Legal entity responsible for the study

North Estonia Medical Centre, Tallinn, Estonia


North Estonia Medical Centre, Tallinn, Estonia


All authors have declared no conflicts of interest.